HomeMy WebLinkAbout0036163-Electric (3 seasons room)1, i-Z,
CITY OF OSHKOSH N® 36163
PERMIT - APPLICATION AND RECORD
TYPE: BLDG ❑ HTG ❑ ELEC PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT ------------ - - - - -- - -- ---------------------------------------------
ADDRESS 4 PLAN NO.
OWNER
DESIGNER
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR /.rh2 ,1161Z,.�1�°�A,C�J�
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH
Lav Sh
WC FDr
Sink LTub
Other
— Disp
DW
SP
— Eject
WSoft
DF
Ur
SS
CBasin
San. Sewer_ — Storm Sewer
Water
FEES: Valuation $ QP *E' Permit Fee Paid $ /S �� Park Dedication $
ISSUED BY Date Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
NT /O NER DATE
ADDRESS
TELEPHONE #
AFFIDAVIT RELATING TO SECTION 13.12
OF THE CITY OF OSHKOSH RELATING TO
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS
WINNEBAGO COUNTY )
(c) OF A GENERAL ORDINANCE
THE LICENSING OF ELECTRICIANS
first being duly sworn on oath, deposes and says that he is not
a licensed electrician In the City of Oshkosh and that he has
applied for an electrical permit to do electrical work in a
residence and /or auxiliary buildings (intended solely for pur-
poses associated with a residence) which is owned and occupied
by him.. or is being constructed in his name, as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or prospective purchasers.
Afflant understands that the electrical words authorized by
the permit applied for in connection with this affidavit, must
be done only by this affiant and that he cannot employ others to
assist with the electrical worts but- members of his immediate
family.
Dated this day of � , 1973.
Subscribed and sworn to before
4
this day of � � l9 �a
I
Notary 7ublic, Winnebago County, Wisconsin
My Commission Expires: �_
A-D'